ACWD Fire Flow Test Application Form

- NOTICE -

FIRE HYDRANT FLOW TESTING SUSPENDED

Due to the ongoing water shortage, the Governor’s declaration of a drought emergency for California, ACWD's Board of Director's declaration of a water shortage emergency and adoption of an ordinance with mandatory water use restrictions aimed at reducing water use by 15% across the Tri-City area, ACWD is taking extraordinary measures to conserve its limited water supplies. One such measure is to suspend routine fire hydrant flow testing.

ACWD is still accepting applications for fire hydrant flow test data, but in most cases, existing historical fire flow test data in the vicinity of the requested flow location will be deemed applicable and will be furnished in lieu of a field fire hydrant flow test. Applicable historical fire flow test data include, but are not limited to, data which are:

1) In the general area of the flow test requested;2) Up to 7 years old, or more in some cases;3) In an area of the water distribution system that has not changed significantly since

the test was conducted.

ACWD makes no representation that the data furnished is necessarily representative of the pressure or flow that can be expected at the location identified on the application.

ACWD may conduct fire hydrant flow testing for certain cases in which applicable historical fire flow test data are not available. In such limited testing, the test will only be performed using 2- 1/2” nozzles of fire hydrants (no 4” nozzle fire flows). Any requests for waivers of this water conservation measure must be accompanied by a written request from the local fire department.

To request historical data, complete the accompanying form and note your request for historical data in the comment area of the form. There is no cost for historical fire flow test data – do not make payment when submitting the application. ACWD will review fire flow test data applications on a weekly basis and will notify the applicant should field fire flow testing be required (in which case the fee noted at the top of the form will be due prior to testing).

ACWD Engineering Department 43885 South Grimmer Blvd. Fremont, CA 94538

See the instructions on the Fire Flow Test Application Form for additional information. If youhave any questions or require additional information about fire hydrant flow testing, pleasecontact Demond Mayfield at (510) 668-4481 or demond.mayfield@acwd.com.

43885 South Grimmer Blvd. P.O. Box 5110 Fremont, California 94537-5110 Phone: (510) 668-4499, Fax (510) 651-1760

ACWD#107 5/1/2018

Note:

APPLICANT CONTACT INFORMATIONRequest Date: Contact Name:Company Name:

Mailing Address: Street Address:

City: State: Zip Code:

Contact Phone Number: ( ) Ext.Mobile Phone Number: ( )Facsimile (Fax) Number: ( )E-Mail:

FIRE FLOW REQUEST INFORMATIONRequested Fire Flow Location:* Street Address:

Cross Street: City:

COMMENTS:

*Although reasonable efforts will be made to perform the fire flow test on the hydrants closest to the requested location, ACWD cannotguarantee that the nearest hydrants will be available for testing. Obstacles (i.e. parked cars, trees, posts, landscaping, etc.) and nozzleconfigurations or flow orientations may prevent ACWD from flowing particular hydrants.

Leaving any empty fields in the the Applicant Contact Information or Fire Flow Request Information sections below could delay your fire flow test results.

FIRE FLOW TEST APPLICATION FORMSUBMIT YOUR APPLICATION, ALONG WITH A CHECK IN THE AMOUNT OF $247.00, PAYABLE TO ALAMEDA COUNTY WATER DISTRICT, TO THEADDRESS ABOVE. PLEASE ATTENTION YOUR ENVELOPE TO THE ENGINEERING DEPARTMENT. COMPLETE ONE (1) FORM FOR EACH FLOW TESTREQUESTED.

SKETCH

WHAT TYPE OF APPLICATION IS THIS TEST REQUESTED FOR? □ □

ACWD ENGINEERING DEPARTMENT 43885 SOUTH GRIMMER BLVD FREMONT, CA 94538 PHONE (510) 668-4499 FAX (510) 651-1760

Multi-Family Residential, Commercial / Industrial or Institutional Project Other ____________________

Payment Received Test Completed Provided Existing Data To Finance Acct. No. 11.6564

FOR ACWD USE

□ □ □ □ Initials

_____ _____ _____ _____

□ □

Please sketch the general location of your requested fire flow test in the space below, or you may send a drawing or map along with your application. 1) If the Test location fronts more than one water main or is on a corner lot, please indicate which water main

should be tested in the Sketch or Comments sections.2) If the static/residual pressure or flow data is required for specific hydrant(s), please indicate which hydrant(s)

should be included in the test in the Sketch or Comments sections*.

If the Application type is not Single Family Residential, provide the Estimated / Required Total Fire Flow to the Site:______________GPM

I would like to receive the results of the test (check all that apply):

By FaxBy E-Mail

□ By Standard Mail (default)

Single Family Residence

□